Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · May 2011
Review[1/1 plasma to red blood cell ratio: an evidence-based practice?].
Coagulopathy during massive haemorrhage increases morbidity and mortality rates. The modalities of treatment by transfusion of fresh frozen plasma (FFP) are a matter of debate. According to most clinical practice guidelines, FFP administration is driven by coagulation tests but, in cases of massive transfusion, patient management may be delayed whilst awaiting results and thawing FFP. ⋯ Actually, very few patients are likely to derive benefit from a 1/1 FFP:RBC transfusion strategy. They are chiefly multiple trauma victims with haemorrhagic shock and cases of ruptured abdominal aortic aneurysm. In other patients, in order to minimize risks and costs, a more parsimonious FFP use policy remains the best option until evidence for the benefit of 1/1 FFP:RBC is demonstrated.
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Ann Fr Anesth Reanim · May 2011
Case Reports[Antibodies against high frequency antigen and total knee replacement].
We report the perioperative management of a woman expressing an antibody against high frequency red cell antigen (anti-Kel4 antibody anti-kpb) who was scheduled for a total knee replacement. A specific strategy was designed to afford this major orthopedic surgery, considering specially the occurrence of unusual bleeding higher than the average bleeding assessed in our hospital in this indication. The transfusion of incompatible red cells may be responsible for acute hemolytic reaction. ⋯ Three autologous red cells units were collected before surgery. Compatible homologous red cells units were also available at the French bank for rare blood groups. We report logistical and medical problems that have occurred during the perioperative period.
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Ann Fr Anesth Reanim · May 2011
Review[The basis of ischemia-reperfusion and myocardial protection].
The myocardial infarction represents a major cause of mortality. The deleterious phenomena arising during the ischaemia and the reperfusion of the myocardium are studied for more than 40 years. ⋯ We know now that the reperfusion itself is also a source of noxious effects (calcium overload, free radicals production, mitochondrion alteration). To combat these deleterious processes, two maneuvers demonstrated their efficiency by protecting the ischemic myocardium : it is the preconditioning and the postconditionning.